Treatment of myelodysplastic syndrome

ABSTRACT

The present invention relates to the use of Volasertib or a pharmaceutically acceptable salt thereof or the hydrate thereof for treating myelodysplastic syndrome (MDS).

The present invention relates to the use of Volasertib or a pharmaceutically acceptable salt thereof or the hydrate thereof for treating patients suffering from myelodysplastic syndrome (MDS).

BACKGROUND OF THE INVENTION

Myelodysplastic syndromes (MDS) are clonal hematopoietic stem-cell disorders characterized by ineffective hematopoiesis, peripheral-blood cytopenias, and increased tendency to progress to acute myeloid leukemia (AML). The age-adjusted incidence of MDS is 3.3 cases per 100,000 people, and this rate appears to be increasing. MDS is primarily a disease of older adults, the median age of patients with MDS is approximately 70 years. This patient population is frequently affected by other comorbid conditions, which often influences treatment decisions. Treatment of MDS is based on prognostic factors that predict survival and progression to AML. Currently, the treatment of patients with MDS is guided by the International Prognostic Scoring System (IPSS). This system stratifies patients into four groups: low, intermediate-1, intermediate-2, and high-risk, based on number of cytopenias, percentage of bone marrow blasts, and karyotype. Low risk and intermediate-1 risk are usually grouped together as lower-risk disease, whereas intermediate-2 risk and high risk are grouped together as higher-risk disease. The survival of patients with higher-risk MDS is significantly different than that of patients with lower-risk disease. Without intervention, median survival of higher-risk patients is close to 12 months. Survival of patients with lower-risk disease is more diverse and ranges from a few months (poor-prognosis, lower-risk disease) to more than a decade. Therefore, the objectives of therapy are different in lower- versus higher-risk disease. While in lower-risk MDS, the goal is to relieve symptoms, manage cytopenias, and minimize the need for transfusions [eg: erythropoiesis-stimulating agents (ESA) and growth factors (GF)], in higher-risk MDS, disease-modifying therapies directed to slowing progression to AML and improving survival are used. These disease modifying therapies include hypomethylating agents (HMA, as e.g. decitabine), intensive chemotherapy, and allogeneic stem cell transplantation (SCT), with SCT currently being the only known curative modality. Despite these treatment alternatives, the prognosis of patients with higher-risk MDS remains very poor owing to the disappointing activity of standard chemotherapy-based therapies, particularly those with therapy-related MDS, the eventual loss of response to HMA, and the restriction of allogeneic SCT to younger patients with an appropriate donor.

Treatment of higher-risk patients is dependent on whether they are considered to be candidates for intensive therapy (e.g., allogeneic SCT or intensive chemotherapy). Clinical features relevant for this determination include the patient's age, performance status, comorbidities, patient's preference and availability of suitable donor and caregiver. The access to allogeneic SCT is restricted to approximately 8% of patients with MDS, owing to advanced age, concomitant comorbidities and/or donor availability. For higher-risk patients who are not candidates for high-intensity therapy, the use of HMA is considered the standard of care.

Volasertib is a highly potent and selective inhibitor of the serine-threonine Polo like kinase (Plk), a key regulator of cell-cycle progression. Volasertib is a second-generation dihydropteridinone derivative with distinct pharmacokinetic (PK) properties. The problem underlying this invention was to develop a new medication for the treatment of MDS.

Volasertib (I) is known as the compound N-[trans-4-[4-(cyclopropylmethyl)-1-piperazinyl]cyclohexyl]-4-[[(7R)-7-ethyl-5,6,7,8-tetrahydro-5-methyl-8-(1-methylethyl)-6-oxo-2-pteridinyl]amino]-3-methoxy-benzamide,

This compound is disclosed in WO 04/076454. Furthermore, trihydrochloride salt forms and hydrates thereof are known from WO 07/090844. They possess properties which make those forms especially suitable for pharmaceutical use. The above mentioned patent applications further disclose the use of this compound or its monoethanesulfonate salt for the preparation of pharmaceutical compositions intended especially for the treatment of diseases characterized by excessive or abnormal cell proliferation.

Document WO 2006/018182 discloses combinations for the treatment of diseases involving cell proliferation.

SUMMARY OF THE INVENTION

Surprisingly, the Plk1 inhibitor Volasertib (I) is advantageously effective in the treatment of patients suffering from myelodysplastic syndrome.

Thus, as a first aspect the present invention relates to a method of treating patients suffering from myelodysplastic syndrome comprising administering an effective amount of the Plk1 inhibitor Volasertib (I) to a person in need of such treatment.

A second aspect of the present invention is Volasertib (I), or a pharmaceutically acceptable salt thereof or a hydrate thereof, for the treatment of a patient suffering from myelodysplastic syndrome, e.g. a pharmaceutical composition comprising Volasertib (I) for the treatment of a patient suffering from myelodysplastic syndrome.

A third aspect of the present invention is the use of Volasertib (I) for preparing a pharmaceutical composition for the treatment of a patient suffering from myelodysplastic syndrome.

A fourth aspect of the present invention is the use of Volasertib (I) for preparing a pharmaceutical kit for the treatment of a patient suffering from myelodysplastic syndrome.

Another aspect of the present invention is the use of Volasertib or a pharmaceutically acceptable salt thereof or a hydrate thereof for the manufacture of a medicament for treating MDS.

Another aspect of the present invention relates to Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof, for use of treating MDS.

Another aspect of the present invention relates to Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof, for use of treating MDS characterized in that 150, 200, 250, 300, 350, 400, 450 or 500 mg of Volasertib are administered.

Another aspect of the present invention relates to Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof, for use of treating MDS characterized in that 150, 200, 250, 300, 350, 400, 450 or 500 mg of Volasertib are administered on day one during a 4 week treatment cycle.

Another aspect of the present invention relates to Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof, for use of treating MDS characterized in that 150, 200, 250, 300, 350, 400, 450 or 500 mg of Volasertib are administered on two days during a 4 week treatment cycle, preferably on day 1 and on one of the days 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 or 21, more preferably on day 1 and on day 8 or on day 1 and on day 15 during a 4 week treatment cycle. Preferably equal doses are administered.

Another aspect of the present invention relates to Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof, for use of treating MDS characterized in that 150, 200, 250, 300, 350, 400, 450 or 500 mg of Volasertib are administered on three days during a 4 week treatment cycle, preferably on day 1 and on two of the days 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 or 21, more preferably on day 1, on day 8 and on day 15 during a 4 week treatment cycle. Preferably equal doses are administered.

Another aspect of the present invention relates to Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof, for use of treating MDS characterized in that 150, 200, 250, 300, 350, 400, 450 or 500 mg of Volasertib are administered on day one during a 3 week treatment cycle.

Another aspect of the present invention relates to Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof, for use of treating MDS characterized in that 150, 200, 250, 300, 350, 400, 450 or 500 mg of Volasertib are administered on two days during a 3 week treatment cycle, preferably on day 1 and on one of the days 5, 6, 7, 8, 9, 10, 11, 12, 13 or 14, more preferably on day 1 and on day 8 or on day 1 and on day 10 during a 3 week treatment cycle. Preferably equal doses are administered.

Another aspect of the present invention relates to Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof, for use of treating MDS characterized in that 150, 200, 250, 300, 350, 400, 450 or 500 mg of Volasertib are administered on three days during a 3 week treatment cycle, preferably on day 1 and on two of the days 5, 6, 7, 8, 9, 10, 11, 12, 13 or 14, more preferably on day 1, on day 5 and on day 10 during a 3 week treatment cycle. Preferably equal doses are administered.

Another aspect of the present invention are the above mentioned uses wherein the treatment is a 2^(nd) line treatment after one prior therapy or the treatment is a 3^(rd) line treatment after two different prior therapies.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows the tumor growth kinetics in a nude mouse xenograft model derived from human AML cell line MV4;11. Tumor-bearing mice were treated for 3 weeks intravenously either with vehicle or once weekly with 10 mg/kg or 20 mg/kg Volasertib (BI 6727), respectively. Median tumor volumes are plotted over time. Day 1 was the first day, day 21 the last day of the experiment. Efficacy results from this xenograft model are considered valid for MDS.

FIG. 2 shows the change of body weight over time in a nude mouse xenograft model derived from human AML cell line MV4;11. Tumor-bearing mice were treated for 3 weeks intravenously either with vehicle or with 10 mg/kg or 20 mg/kg Volasertib, respectively, once weekly. Median changes in body weight compared to day 1 are plotted over time. Day 1 was the first day, day 21 the last day of the experiment.

DETAILED DESCRIPTION OF THE INVENTION

The 3 week or 4 week treatment cycle starts with the day of the first administration of Volasertib as day one of the 3 week or 4 week treatment cycle.

The method of treatment according to the invention comprises administration of a therapeutically effective amount of Volasertib (I) or a pharmaceutically acceptable salt thereof or a hydrate thereof to a patient in need thereof.

In accordance with the present invention Volasertib may be preferably administered by parenteral (e.g. intramuscular, intraperitoneal, intravenous, transdermal or subcutaneous injection), and may be formulated, alone or together, in suitable dosage unit formulations containing conventional non-toxic pharmaceutically acceptable carriers, adjuvants and vehicles appropriate for each route of administration. Dosage forms and formulations of the active ingredient suitable within the present invention are known in the art. For instance, such dosage forms and formulations include those disclosed for Volasertib in WO 2006/018221.

Dosages/Volasertib:

For intraveneous treatment Volasertib (I) may be administered to the human patient in a daily dose of 150 to 500 mg/application, in another embodiment 150, 200, 250, 300, 350, 400, 450 or 500 mg/application, yet in another embodiment 300 or 350 mg/application. For instance, Volasertib can be administered as a slow intravenous infusion over several hours, e.g. over about 1, 2, 4, 6, 10, 12 or 24 hours, preferably about 1 or 2 hours.

However, it may optionally be necessary to deviate from the amounts specified for Volasertib (I), depending on the body weight or method of administration, the individual response to the medication, the nature of the formulation used and the time or interval over which it is administered. Thus, in some cases, it may be sufficient to use less than the minimum quantity specified above, while in other cases the upper limit specified will have to be exceeded. When large amounts are administered it may be advisable to spread them over the day in a number of single doses.

Dosage Forms and Formulation Aspects:

Within the context of the invention, Volasertib (I) is optionally applied in the form of the tautomers and pharmaceutically acceptable salts thereof. Pharmaceutically acceptable salts are preferably selected from the group consisting of the hydrochloride, hydrobromide, hydroiodide, hydrosulphate, hydrophosphate, hydromethanesulphonate, hydronitrate, hydromaleate, hydroacetate, hydrobenzoate, hydrocitrate, hydrofumarate, hydrotartrate, hydrolactate, hydroxalate, hydrosuccinate, hydrobenzoate and hydro-p-toluenesulphonate, preferably the hydrochloride, hydrobromide, hydrosulphate, hydrophosphate, hydromaleate, hydrofumarate and hydromethanesulphonate. In a particularily preferred embodiment Volasertib (I) is applied as its trihydrochloride salt forms and hydrates thereof as disclosed in WO 07/090844.

Dosages or amounts of the active ingredient provided in the context of this invention refer in any case to the free base equivalent, that is Volasertib in the free base form.

The term “therapeutically effective amount” shall mean that amount of a drug or pharmaceutical agent that will elicit the biological or medical response of a tissue system, animal or human that is being sought by a researcher or clinician, resulting in a beneficial effect for at least a statistically significant fraction of patients, such as an improvement of symptoms, improvement of peripheral blood cell counts, a cure, a reduction in disease load, reduction in tumor mass or leukaemia cell numbers, extension of life, or improvement in quality of life.

Within the present invention the term “MDS” is to be understood to encompass all forms of myelodysplastic/myeloproliferative neoplasms (MDS/MPN) and myelodysplastic syndromes according to the 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia. These are:

-   -   Myelodysplastic/myeloproliferative neoplasms (MDS/MPN)         -   Chronic myelomonocytic leukemia         -   Atypical chronic myeloid leukemia, BCR-ABL1-negative         -   Juvenile myelomonocytic leukemia         -   Myelodysplastic/myeloproliferative neoplasm, unclassifiable         -   Provisional entity: refractory anemia with ring sideroblasts             and thrombocytosis     -   Myelodysplastic syndrome (MDS)         -   Refractory cytopenia with unilineage dysplasia         -   Refractory anemia         -   Refractory neutropenia         -   Refractory thrombocytopenia         -   Refractory anemia with ring sideroblasts         -   Refractory cytopenia with multilineage dysplasia         -   Refractory anemia with excess blasts         -   Myelodysplastic syndrome with isolated del(5q)         -   Myelodysplastic syndrome, unclassifiable         -   Childhood myelodysplastic syndrome         -   Provisional entity: refractory cytopenia of childhood

Another aspect of the present invention relates to Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof, for use of treating MDS selected from the group of chronic myelomonocytic leukemia, juvenile myelomonocytic leukemia, refractory anemia with ring sideroblasts, refractory cytopenia with multilineage dysplasia and refractory anemia with excess blasts.

The following Examples serve to illustrate the invention without restricting it:

Cells

MV4;11 (CRL-9591) cells were obtained from ATCC. According to the Catalogue of Somatic Mutations in Cancer of the Wellcome Trust Sanger Institute, UK, this cell line carries a mutation in the FLT3 gene. Cells were cultured in T175 tissue culture flasks at 37° C. and 5% CO₂. The medium used was IMDM supplemented with 10% fetal calf serum, 1% NEAA, 1% sodium pyruvate and 1% glutamine.

Mice

Mice were 8-9 week-old athymic female BomTac: NMRI-Foxn1^(nu) purchased from Taconic, Denmark. After arrival in the animal facility, mice were allowed to adjust to ambient conditions for at least 3 days before they were used for experiments. They were housed in Macrolon® type II cages in groups of 5 under standardized conditions at 21.5±1.5° C. temperature and 55±10% humidity. Standardized diet (PROVIMI KLIBA) and autoclaved tap water were provided ad libitum.

Establishment of Tumors, Randomization

To establish subcutaneous tumors, MV4;11 cells were harvested and resuspended in PBS+5% FCS at 5×10⁷ cells/ml. 50 μl of the cell suspension containing 2.5×10⁶ cells was then injected subcutaneously into the right flank of the mice (1 site per mouse). Growth factor reduced BD Matrigel™ Matrix (BD Biosciences) was added to the cell suspension at a ratio of 1:1 before the injection. When tumors were well established and had reached a tumor volume of ˜90 mm³, mice were randomly distributed between the treatment and the vehicle control groups 12 days after injecting the cells.

Administration of Test Compound

Volasertib (BI 6727) was dissolved in hydrochloric acid (0.1 N), diluted with 0.9% NaCl and injected intravenously into the tail vein. An administration volume of 10 ml per kg body weight was used. The solution was freshly made up each injection day.

Monitoring Tumor Growth and Side Effects

The tumor diameter was measured three times a week with a caliper. The volume of each tumor [in mm³] was calculated according to the formula “tumor volume=length*diameter²*π/6”. To monitor side effects of treatment, mice were inspected daily for abnormalities and body weight was determined three times a week. Animals were sacrificed at the end of the study when the control tumors reached a size of approximately 1100 mm³ on average. In addition animals with tumor sizes exceeding 2000 mm³ were sacrificed early during the studies for ethical reasons.

Example 1 Nude Mouse Xenograft Model Derived from Human AML Cell Line MV4;11

Results of an experiment comparing treatment of xenografts in mice either with vehicle or once weekly with 10 mg/kg or 20 mg/kg Volasertib, respectively, are shown in FIG. 1. Animals were treated for 21 days.

Treatment with 10 mg/kg Volasertib once a week i.v. showed reduced tumor growth compared to vehicle (median T/C=76%; T/C: ratio of median tumor volume of treated vs. control tumors). Beneficial side effect profile was demonstrated as body weight gain was comparable to vehicle as shown in FIG. 2.

Treatment with 20 mg/kg Volasertib once a week i.v. showed reduced tumor growth compared to vehicle (median T/C=38%). Beneficial side effect profile was demonstrated as body weight gain was comparable to vehicle as shown in FIG. 2. 

1. A method of treating MDS comprising administering to a patient a therapeutically effective amount of Volasertib, optionally in the form of a pharmaceutically acceptable salt thereof or a hydrate thereof.
 2. The method according to claim 1 wherein the treatment is a 2^(nd) line treatment after one prior therapy or the treatment is a 3^(rd) line treatment after two different prior therapies.
 3. The method according to claim 1 wherein higher-risk MDS is treated.
 4. The method according to claim 1, wherein 150 to 500 mg of Volasertib or a pharmaceutically acceptable salt thereof or a hydrate thereof are administered per day of administration.
 5. The method according to claim 4 wherein Volasertib is administered on one day during a 4 week treatment cycle.
 6. The method according to claim 4 wherein Volasertib is administered on two days during a 4 week treatment cycle.
 7. The method according to claim 4 wherein Volasertib is administered on three days during a 4 week treatment cycle.
 8. The method according to claim 4 wherein Volasertib is administered on one day during a 3 week treatment cycle.
 9. The method according to claim 4 wherein Volasertib is administered on two days during a 3 week treatment cycle.
 10. The method according to claim 4 wherein Volasertib is administered on three days during a 3 week treatment cycle.
 11. A pharmaceutical kit comprising a therapeutically effective amount of Volasertib or a pharmaceutically acceptable salt thereof or a hydrate thereof for use of treating MDS. 